UK: How Can We Tackle Loneliness In Older People?

In our report in 2014,
Better care for frail older people, we identified, among many
other concerns, the issue of chronic loneliness which evidence
suggests is as bad for health as smoking 15 cigarettes a day.
Indeed, I had previously written a blog in 2013 on
Chronic Loneliness - the next Public Health Challenge. I was
therefore delighted when one of our new joiners, offered to write
this week's blog on tackling loneliness in older people, based
on her first-hand experience and I hope that if more of us
implement some of the suggestions then we can start to reverse this
rising trend.

Throughout my student nurse training, I worked as a care
assistant during university holidays. One sunny Sunday I was
working on what was then referred to as a Geriatric ward (now
rightly referred to as 'Care of the Elderly'). A female
patient, who was very frail and slightly confused told me it was
her birthday and that her family would be coming to visit. At lunch
time I offered her some food but understandably she didn't want
any because her family "always bring cake".

2pm visiting time came and went, the usual hustle and bustle of
the ward continued but she had no visitors. I assumed she had
mistakenly believed that it was her birthday so I checked her date
of birth and it was her birthday. I was sure her family would come
during evening visiting hours but this came and went and still no
one had come. Next of kin details said there was a son who
didn't live too far away and a daughter who did. At the end of
my shift I went to buy her a card, so someone had at least
acknowledged her birthday. It felt like an empty consolation.

I'll never know what was preventing her family from visiting
that day. I hope that it wasn't simply that they didn't
care, but I remember feeling sadness that this may have been the
reason they hadn't come. This, and similar experiences sparked
my passion for improving elderly care and dignity for older people.
Throughout my nursing career I repeatedly saw this scenario, and
realised that despite the hustle and bustle of a hospital ward or a
care home, people can still be desperately lonely. However, the
understandable necessity for task driven care is no consolation for
neglecting personal interaction. Whilst it is the ultimate
privilege to 'nurse' someone who is frail and vulnerable,
the value of spending time with them, to read to them or simply to
talk, is often overlooked. As the statistics below show, this is
not a problem that is going to go away, and why finding some
solutions is increasingly important.

How does loneliness impact the health system?

Over the next 20 years, the population of older people over 65
years of age is expected to increase by 50 per centi and
those over 85 years are expected to grow at the fastest
rateii. This latter segment are increasingly frail and
have a greater risk of being isolated from the local community as a
result. Age UK found that in people aged over 80, self-reported
loneliness is 50 per cent.iii Moreover, the
'Campaign To End Loneliness' report that over half of all
people over 85 claim their TV is their only
company.iv Loneliness in older people can happen
suddenly through bereavement, or gradually as a result of our
modern day lives and the increase in social mobility that often
results in families and children moving away. Busy family and work
lives or having a young family later in life are also reasons given
for failing to visit elderly relatives.

The adverse health effects of loneliness are well documented as
is the obvious emotional toll. Disturbed sleep, high stress and
anxiety levels resulting in high blood pressure and poor nutrition
all of which represent risks factors for admission into an acute
hospital setting, where capacity is low and costs are
high.v For example, between 2011 and 2014, there has
been an annual increase in emergency admissions to hospital for
people aged over 75 of two per cent a
yearvi demonstrating how the growing problem of an
ageing population is impacting demand on front line NHS
services.

How can we tackle loneliness in older people?

Research suggests that the success of interventions designed to
combat loneliness vary. Identifying people in need can also be a
challenge. One suggestion could be to use Local Authority data for
people who have just been bereaved or who request assistance, for
example in putting out their rubbish can help paint a picture of
who in the local community might be lonely and where resources
could be directed.

The telecare and telehealth markets are starting to make an
increasing contribution to improving continuous contact with older
people. Laing and Buisson report that if deployed properly,
telecare and telehealth can create up to £1 billion of
savings per year for the NHS and improve people's
lives.vii Their use can help stimulate a range of
benefits such as a sense of confidence, and a communication
lifeline. There are new emerging technologies which allow families
to stay in touch even if an older person isn't 'tech
savvy'. Companionship technology, which is more popular in the
USA, if adopted over here could provide further unquantified cost
benefits to the NHS and Adult Social Care budgets but also can add
a huge amount of emotional value, which is arguably more
precious.viii

There are small things that each of us could do. I am lucky that
my parents (who aren't that old) live very close and I hope to
always play a part in their care in the future. In the meantime
there are multiple volunteer opportunities to help in local
communities and support lonely older people. Contact The Elderly
has a scheme called 'Spare Chair Sunday' where a family who
has a spare chair at their table hosts an older person from their
local community who would otherwise be eating alone.ix
My family have signed up and look forward to hosting someone soon.
Shifting attitudes so that we all do something small to combat
loneliness and boost local resources is a good place to start, as
is tackling the paucity of formal research into loneliness which
could be hugely beneficial for all of us.

The content of this article is intended to provide a general
guide to the subject matter. Specialist advice should be sought
about your specific circumstances.

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